Initial Management of

Acute Sports Injuries

By Martin Meyer

Sports Physiotherapist

Director APE

Sports Medicine

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What we will cover...

1. Pathology of acute injuries and the

healing process

2. Initial Assessment of injuries Spinal Emergency

DRABC

TOTAPS

3. Immediate First Aid treatment RICER

No HARM

Blood

Pathology of injury

Initial Injury

Tissue damage

Bleeding due to capillary damage

Increased water drawn to the area

Bodies own “injury army” attracted to area

Chemicals released into area

Results in...

1. Swelling

2. Inflammation

3. Heat

4. Bruising

5. Pain

The Healing Process

Acute Phase of Injury (24 hrs -72hrs)

Bleeding continues from damaged capillaries

Dying cells release chemicals/ toxins that irritate nerve endings → pain

Swelling is made up of bodies “injury army” and leakage

of fluid from damaged tissues. Increased pressure leads

to more tissue damage and cell death.

Blood vessels dilate → increased blood flow → are becomes pink, warm and swollen

The Healing Process

Sub-Acute Phase (3+ days – weeks)

Removal of debris macrophages and lymphatic system

Re-Capillarisation Capillaries begin to regrow

Scar tissue Scar tissue development begins

Laying of new damaged tissue begins- collagen

Building blocks of new tissue

The Healing Process

Remodelling (weeks to years…)

The initial collagen matrix layed down is remodelled over time.

Collagen is initially messy and un-organised. This is re-organised and slowly becomes original tissue again.

Collagen develops strength through lines of stress

Collagen that is messy, unorganised and weak is more likely to be re-injured

Rehabilitaiton important in this phase to ensure proper healing of collagen

Examples

Assessment of Player Situation

Danger

Response

Airway

Breathing

Circulation

DRABC

Spinal Injury Signs

History of head injury

History of neck injury

Pins and needles in limbs

Numbness in limbs

Unable to move limbs- hands/feet

Marked neck/lumbar pain

Wait until trained personnel arrive to help

Initial Assessment of Injuries

Talk

Observe

Touch

Active

Passive

Skills

TOTAPS

Deciding if a player can continue on...

TALK

What happened?

What was the mechanism of injury?

Where does it hurt?

Did you hear any sounds ie cracks,

snaps?

The story of how it

happened tells you

a lot about the

injury

Observe

Look for obvious deformity

If it doesn’t look right....

It probably isn’t...

Look for swelling

Look for discolouration

Compare the bad side to the good side

Touch

Tenderness – mild

moderate

severe

Location- soft tissue

bony

Heat/ Temperature- If hot more blood

Active Movement

Assess how much movement athlete can

do by themselves..

Is it Full Range?

When does it get painful?

Where is it painful?

Passive Movement

How much movement is there passively?

ie movement YOU can make

Compare the bad side to the good side

http://www.sma.org.au/images/sportstrainer.jpg

Skills

If all OK so far.. then need to test the

athlete with sport specific skill..

Running on the spot

Hopping

Jumping

“Z” running

Must be something to test the injury..

TOTAPS Flow ChartTalk

Touch

ObserveSignificant deformity

Remove

Player

Bony Tenderness

Severe tenderness

Active Painful/ loss of range

Passive Painful/ loss of range

SkillsPain

Instability

Significant swelling

More examples......

Initial Treatment of Injuries

Rest

Ice

Compression

Elevation

Referral

Most important in

the first

24-72 hours

RICER

Aim-

• Reduce further damage to tissue

• Prevent excessive scar formation

REST

Remove player from field

Rest injured area

Immobilise area

Why?

Reduces further tissue damage

Reduces blood flow

Allows for full assessment of injury

ICE

Icing

Ice bags- gel packs, frozen peas

Instant ice packs

Ice water baths

20 mins on/ 2 hours off

Why? Cools the area

→ constricts blood vessels

→ reduces blood flow and fluid leakage

→ less swelling, pressure and pain

COMPRESSION

Compress injured area

Elastic Bandage

Cohesive bandage

Strapping

Move distal to proximal

Why?External pressure reduces fluid leakage and

bleeding into tissues

Provides support the area

Immobilises the area ie REST

ELEVATION

Elevate area above heart

On chair

Medical kit

Why?

Reduces bleeding as blood has to flow up hill

Gravity helps swelling to move towards lymph

nodes

REFERRAL

Physiotherapist

Hospital

Doctor/GP

Why?

Diagnosis

Treatment can commence

The sooner treatment begins, the better the

outcome

Summary

Reduce

Inflammation

Bleeding

Scar tissue

Improve

Healing time

Healing quality

Time away from sport

No HARM

HeatH

A

R

M Massage

Running

Alcohol

NO.......

Most important in

the first

24-72 hours

No Heat

Includes

Hot packs

Saunas

Spas

Why?

Increases blood flow to area therefore

increases swelling

No Alcohol

Includes

Most things adults enjoy after a game of

sport!

Why?

Thins blood increases swelling

In excess brings on silly behaviour

Less pain felt therefore more damage caused

Adds to toxins already in injured area

No Running

Includes

Running

Any exercise that is painful

Why?

Increase in tissue damage

Overload to other areas as compensation

No Massage

Includes

Rub downs

Massages

Mobilisations

Why?

May increase tissue damage

Increases blood circulation to the injured area

Bleeding

Cuts

Lacerations

Impact injuries

Universal Precautions

must be used

at all times

Aims1. Stop bleeding

Compression

Anusol

Alginate stop bleed products

Vaseline

2. Clean wound NaCl irrigation

Betadine/iodine wipes

3. Close/Dress wound Steri/Leuko strips

Sterile dressing- bandaid/primapore

Bandage down to continue play

Key Points

Understand pathology of injury

Use DRABC in any situation

Understand the Emergency Signs for

spinal injury

Use TOTAPS to decide whether a player

can continue

Use RICER and No HARM for initial injury

management

Stem blood flow

Thank You

Questions??